Thank you for your question. You submitted a photo of your lips and you state in your
question that approximately 6 days earlier, you had Restylane placed about .5 cc and you
felt like the left side doesn’t look right. You contacted the practitioner who performed
the treatment and was advised that it didn’t appear to be significant to them and that
they would see you in about a week to massage the area. And you state you are not happy
with their answer.
Well, I can certainly offer you some guidance to how I treat my patients in my practice.
I’m a board certified cosmetic surgeon and a fellowship trained oculofacial plastic and
reconstructive surgeon. Injectable fillers are very significant in my practice over 20
years and I actually use the original collagen Zyderm and Zyplast back in the day before
the hyaluronic acid fillers were introduced with Restylane introduced in 2005.
So certainly the challenge with any injectable filler when it comes to lips is to get just
enough in the right places just to create a nice result. And in fact, with lips, there
is a basically a rule of 1/3 to 2/3 or a golden ratio of 1 to 1.6. Essentially, the idea is
to balance the lip in a way that when I look at people’s lips, I look at basically certain
elements of the lips. And those elements are including the lip boarder, the pink part of
the lip, the cupid’s bow, as well as the philtrum. All of these have to be right and
as well as the outer corners. So all of these things become automatic when you’ve been
doing something this long.
Now with that being said, I am sure the practitioner did not intentionally expect that there would
be a little bit more volume on the left side compared to the right. Hence, the question
of course is whether or not it is something you want to deal sooner rather than later.
I would suggest that your practitioner is probably on point here. When I have my patients
undergo any injectable treatment and we use a lot of injectables in our practice, we do
injectables for volume augmentation on the cheeks, nasolabial folds, Botox™, Dysport,
Live Juvederm, a lot of Restylane. So certainly, this strategy of from what we do in our practice
is to have people come back after 2 weeks. And the reason I use 2 weeks as a rule or
guideline is that it takes several days for the material to actually become more integrated
into the tissue. When you inject into the lips, more often than not, there is going
to be a certain amount of swelling and the reactive swelling is immediate. And so, when
you are doing these injections, you are moving in a relatively fast pace but at the same
time, you want to sculpt very carefully.
Now, when there is swelling, it does throw off with the volume and how much volume is
there. Chances are with a volume of half a cc being used for your lips, there isn’t
a lot of volume in that area that looks a little bit elevated. What I explain to my
patients is that the materials in the tissue, it can coalesce a little bit and can be elevated
but the movement in your case or anyone’s case where the movement of the mouth the smiling,
the talking, the moving in a way can help massage the shape of the material to a point
where it blends in. And so you don’t want to be over eager coming to soon and try to
have a material dissolve that is not optimum because then you don’t have the result you
wanted.
Massaging is part of the practice. For me, it is often done at the time of the procedure.
Sometimes with other situations, I’ll do it a little bit earlier. A couple of days
later, the person is concerned and then they come in with this type of concern and we can
always massage a little bit and I can always massage it more effectively than the patient
and we are trying to help people look their best as soon as possible. So there could be
some role in you seeing your provider a little bit sooner rather than later. If this doesn’t
improve, you can also try gently massage this yourself but then again, consult your provider
before you go ahead and do that. But as far as the 2 week window, certainly that is well
within our standard of care and I think that it is very responsible to do that as what
we do routinely in our practice.
So I hope that was helpful, I wish you the best of luck and thank you for your question!